Distal coronary embolisation during transcatheter aortic valve implantation

A 92-year-old woman was admitted to a hospital with severe aortic valve stenosis for transcatheter aortic valve implantation (TAVI). TAVI was performed under general anaesthesia. After balloon valvuloplasty, the patient became hypotensive and transesophageal echocardiography showed severe aortic regurgitation with severely depressed left ventricular wall motion. A 26 mm Sapien XT valve was deployed. However, the ventricular wall motion was still severely depressed. Coronary angiography showed occlusion of the mid-left anterior descending (LAD) artery. After crossing a 0.014″ guidewire, manual vacuum aspiration was conducted and multiple emboli were removed. 2 drug-eluting stents were deployed in the LAD artery. Following this, the left ventricular wall motion improved. The patient's failure symptoms improved remarkably after TAVI. Histopathological examination of the aspirated emboli was compatible with a recent thrombus containing platelets, fibrin, erythrocytes and leucocytes. This is the first report to describe a distal coronary embolisation during TAVI with histopathological confirmation of the embolus.